Family nurture intervention in the NICU increases autonomic regulation in mothers and children at 4-5 years of age: Follow-up results from a randomized controlled trial

Martha G Welch; Joseph L Barone; Stephen W Porges; Amie A Hane; Katie Y Kwon; Robert J Ludwig; Raymond I Stark; Amanda L Surman; Jacek Kolacz; Michael M Myers

doi:10.1371/journal.pone.0236930

Family nurture intervention in the NICU increases autonomic regulation in mothers and children at 4-5 years of age: Follow-up results from a randomized controlled trial

PLoS One. 2020 Aug 4;15(8):e0236930. doi: 10.1371/journal.pone.0236930. eCollection 2020.

Authors

Martha G Welch^{1

2}, Joseph L Barone¹, Stephen W Porges^{3

4}, Amie A Hane^{1

5}, Katie Y Kwon¹, Robert J Ludwig¹, Raymond I Stark¹, Amanda L Surman¹, Jacek Kolacz⁴, Michael M Myers^{1

2}

Affiliations

¹ Department of Pediatrics, Columbia University Medical Center, New York, NY, United States of America.
² Department of Psychiatry, Columbia University Medical Center, New York, NY, United States of America.
³ Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
⁴ Traumatic Stress Research Consortium, Kinsey Institute, Indiana University, Bloomington, IN, United States of America.
⁵ Department of Psychology, Williams College, Williamstown, MA, United States of America.

Abstract

Background: Maturation of multiple neurobehavioral systems, including autonomic regulation, is altered by preterm birth. The purpose of this study was to determine the long-term effects of Family Nurture Intervention (FNI) in the NICU on autonomic regulation of preterm infants and their mothers.

Method: A subset of infants and mothers (48% of infants, 51% of mothers) randomly assigned to either standard are (SC), or SC plus the FNI in the NICU in a prior RCT (ClincalTrials.gov; NCT01439269) returned for follow-up assessments when the children were 4 to 5 years corrected age (CA). ECGs were collected for 10 minutes in mothers and their children while children were in their mothers' laps. Heart rate, standard deviation for heart rate, respiratory sinus arrhythmia (RSA)-an index of parasympathetic regulation, and a measure of vagal efficiency were quantified.

Results: Both children and mothers in the FNI group had significantly greater levels of RSA compared to the SC group (child: mean difference = 0.60, 95% CI 0.17 to 1.03, p = 0.008; mother: mean difference = 0.64, 95% CI 0.07 to 1.21, p = 0.031). In addition, RSA increased more rapidly in FNI children between infancy and the 4 to 5-year follow-up time point (SC = +3.11±0.16 loge msec2, +3.67±0.19 loge msec2 for FNI, p<0.05). These results show that the rate of increase in RSA from infancy to childhood is more rapid in FNI subjects.

Conclusion: Although these preliminary follow-up results are based on approximately half of subjects originally enrolled in the RCT, they suggest that FNI-NICU led to healthier autonomic regulation in both mother and child, when measured during a brief face-to-face socioemotional interaction. A Pavlovian autonomic co-conditioning mechanism may underly these findings that can be exploited therapeutically.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Autonomic Nervous System / physiology
Autonomic Nervous System / physiopathology*
Autonomic Nervous System Diseases / therapy*
Child, Preschool
Cohort Studies
Follow-Up Studies
Humans
Infant, Premature / physiology*
Intensive Care Units, Neonatal*
Mother-Child Relations*
Mothers*
Respiratory Sinus Arrhythmia

Associated data

ClinicalTrials.gov/NCT01439269

Grants and funding

Funding was provided by The Einhorn Family Charitable Trust (MGW), The Fleur Fairman Family (MGW), Mary Dexter Stephenson (MGW). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.